Confused About Whole Mouth Dentistry vs. Natural Balance Dentistry?

Confused About Whole Mouth Dentistry vs. Natural Balance Dentistry?

Wednesday, January 13, 2016

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Corrections of a slant mouth with dentistry. Before and after. (Photo: Raymond Q. Hyde, DVM and Amy DoBranski, B.S., EqDT)

Motorized Equipment vs. Hand Tools
Many dental practitioners use a combination of both hand tools and power tools during a dental visit. Both types of equipment are not natural – they are man made. Why does it have to be an “either-or” situation and the blanket condemnation of motorized tools by the natural balance dentistry movement? Both types of instruments are valuable tools to promote the health and comfort of horses. Damage to the dentition is rarely a concern provided the practitioner has sufficient dental training and knows not to overheat a tooth or open a pulp chamber. The practitioners doing this sort of damage are not properly trained, and overly-aggressive dentistry using hand tools or motorized tools should be avoided.

Motorized equipment is not the culprit here. In many cases they are gentler than hand tools for making changes in the mouth. Electric or air-driven instruments can offer more dexterity than hand tools, and can allow for the safe completion of some dental services that can not be provided with hand tools. When is the last time you saw a human dentist (D.D.S.) drill a cavity or a root canal by hand, without a motorized drill? Equine dentistry has progressed beyond the days of only the manual filing of teeth. Yes, horses can now get fillings, root canals, and periodontal treatments with diastema burring, which all involve motorized equipment. Large hooks can now be reduced safely without having to use cutters. It seems “natural” dentists do not offer these advanced services. Do they believe in using modern technology, like X-ray diagnostics?

For geriatric horses with short root structures, motorized tools offer a gentler way to balance the mouth without rocking the teeth back and forth (as with hand tools) and the potential of loosening the teeth. A spinning motorized dental instrument with its tiny diamond abrasive surface does not cause this rocking effect.

Damage to the soft tissue with motorized tools seems to be a concern for the natural balance movement. The fact is you can do as much or more soft tissue damage with hand tools. When a dental practitioner works with motorized tools, he does so with a halogen headlight that illuminates the entire oral cavity well. He can see exactly which tooth he is addressing. Damage to the soft tissue is more likely with an inexperienced practitioner with hand tools who can not see exactly where the tooth ends and the gum tissue begins. One swipe against the gumline does a good bit of damage.

While we are not advocates of the “10 Minute Power Float”, the efficiency of motorized tools results in a shorter work time. This equals more comfort for the horse in the form of fewer TMJ flare-ups by keeping the mouth open for minimal periods of time and accomplishing balance of the dentition in a more timely fashion.

Hand tools have been around for a long time but that doesn’t mean they “fit” the mouth better or are more “natural” than motorized equipment. In the natural hoof care movement we have seen many people start using power equipment on the feet because it is more efficient.

Also compare a modern electric spinning toothbrush with the cumbersome toothbrushes of the past used by humans for years and years. Why did we keep using those ineffective models that didn’t reach many tooth surfaces?

Importance of Balanced Incisors
Contrary to what the natural balance movement states, whole mouth dentistry does not ignore the incisors and their importance to maintaining a balanced mouth. Most horses start needing incisor reductions and levelling during their dental visits before the age of ten. Being domesticated means that horses don’t wear the incisors as much as they should in most cases due to lifestyle and horse-keeping practices, soft feeds, and tender hybrid grasses that are less abrasive to the teeth. The upper and lower rows of teeth should have occlusion on all 24 cheek teeth and the 12 incisors.

Position of Head during Dental Procedures
While a head down position is favored by natural balance dentistry, working in a head neutral position is just as effective. Actually, when the mouth is properly balanced the teeth are free to move in ANY direction as the mandible and maxilla should have both lateral and anterior-posterior freedom of movement. Accommodations can certainly be made for horses which prefer to have their head down, but there is nothing damaging or limiting by balancing the mouth in the head neutral position on a padded headstand or properly used dental head collar/sling. Resting the head on a stand and using a good headlight, may allow for better visualization of dental problems and allow for more precise work.

Unfortunately many persons do an inadequate examination, and miss many problems that are present. A “Natural Balance” equine dentist recently performed dental care on a horse that was losing weight, but with no good results. An I.A.E.D. certified equine dental technician examined the same horse 2 weeks later, (using a headstand and light) and removed 3 loose infected cheek teeth that were overlooked! The horse recovered weight quickly.

Floating Teeth and Bit Seats
“Natural Balance” promoters often say that bit seats create instability in the mouth which leads to TMJ imbalances. There is simply not enough tooth ground away to effect TMJ mobility – only a small portion of the second premolars is rounded for comfort – which is only about 5 % of the occlusal surface. This small loss of occlusal surface is compensated for by establishing a more effective grinding surface and increasing cheek teeth contact through proper incisor work if needed. A bit seat is not natural – it is man made to alleviate discomfort from the use of a bit which is also man made. Without bit seats, horses will frequently acquire painful cuts on the cheek tissue from the sharp, pointed second premolars. Even bitless horses cut themselves here quite frequently. Why would we want to decrease the horse’s level of comfort by not creating bit seats in ridden horses?

Cheek Teeth Angles
Rounding the sharp lingual and buccal points does not change or decrease the natural angle of the cheek teeth as stated by the natural balance movement. Smoothing the upper buccal and lower lingual enamel ridges allow the horse to be more comfortable for longer periods of time between visits. Once again, aggressive dentistry should be avoided. It is often better to do a little less, but more often, to keep your horse comfortable. Over floating the buccal and lingual points by a poorly trained practitioner will result in a smaller occlusal surface and should be discouraged. Properly trained dental practioners maintain and restore the angles and occlusion, as needed, by each individual horse.

In conclusion, whole mouth balance is achieved by whole mouth dentistry. The good practitioner respects the natural biomechanics of the TMJ, and the function of the cheek teeth and incisor tables. Nature does make mistakes in forming and aligning the teeth and accidents and infections cause damage to teeth. Our job is to help restore balance and harmony. These concepts have been studied by whole mouth dental practitioners for years, and we are still learning and teaching a holistic approach which involves respect for the entire horse, nature’s grand design, and the horse’s environment. Our goal is to help horses as much as we can through greater understanding and more complete care.